End of Life Care

1
End of Life Care

• Gordon J Pownall
• Community Commissioning ManagerCommissioning
  Lead for End of Life and Palliative Care
• NHS Hertfordshire

2
Usual place of residence

• The latest figures from the Care Quality
  Commission show there are over 460,000 residents
  living in 17,740 nursing and residential homes
  across England.
• Latest statistics indicate that 18 of people
  died in care homes between 2008 2010 compared
  with 29 of those on an Electronic Palliative
  Care Co-ordination System (EPaCCS) who say they
  would prefer to die in their care home setting.
• Meanwhile 16 of care home residents are still
  admitted to hospital within the last week of
  their life and die there 1.
• 1. What we know now that we didnt know a year
  ago New intelligence on end of life care in
  England. NEoLCIN, May 2012.

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Integrated Care for End of Life
4
Place of death 2011/12
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What are the issues?

• Care homes are often seen as the poor relation
  when it comes to end of life care training and
  awareness-raising.
• The rapid turnover of the workforce combined with
  heavy workload demands can make it particularly
  challenging to organise training and embed the
  learning.
• Homes are often isolated from each other and
  often the rest of health and social care services
  this serves to exacerbates the issue of poor
  integration.
• Perception of additional pressures (financial and
  human) on smaller organisations / services taking
  staff away from primary roles in service
  delivery
• Lack of understanding what is being asked of you
  and more importantlyWHY!

6
Actions we have

• Implementation of AMBER in East and North Herts
  Hospital
• Hospice opening 24/7 Pilot in West Herts
• Extension of Hospice at Home to cover the gap in
  St Albans and Harpenden
• Extension of funding to education in care and
  nursing homes
• Planned implementation of cAMBER pilot in West
  Herts

Additional investment for 2012/13 on pilot
initiatives - 500,000
7
So what is the current picture?

• A recent NEoLCP survey of 56 end of life care
  facilitators, representing 5,693 care homes,
  showed significant increases in the
  implementation of -
• Gold Standard Framework
• ACP
• Liverpool Care Pathway between 2010 and 2011.
• A more in-depth survey of 12 of these
  facilitators, representing 1,768 homes, indicates
  that the uptake is still quite low.
• Just over 20 of homes were making use of ACP
  while use of tools such as GSF, LCP, PPC and
  local approaches were significantly below this.
• Even in the nursing home sector, uptake of each
  of these approaches was below 50.

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Making adjustments and supporting initiatives

• It is also crucial to have the support of the
  care home manager and to have people working on
  the ground as (end of life) care champions,
  ensuring the individual is always at the centre
  of the care planning process.

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What challenges can we overcome?

• Invest in activities that promote advance care
  planning (to reduce hospital admissions, AE
  attendances, unnecessary use of ambulances)
• Invest in services that support people to remain
  where they wish (to encourage and promote respect
  for an individual to choose to die in their
  preferred place whether you are staff, relative
  or other professional)
• To understand the impact on the wider community
  where we react rather than respond (to promote
  and make best use of the limited resources we
  have available and ensure the right care is
  always available)

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We need your support to -

• Record your activity evidence the work
• Dont tell me show me!
• Admissions to Hospital
• Advance Care Planning
• DNACPR decisions
• How you support service users through care
  planning and involve them in the decision making
• Show how you ensure service users are active
  participants, not passive recipients
• Without this evidence, we cannot promote and
  influence the changes you know are needed

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Actions we will

• Encourage GPs to identify their 1
• Continue to work closely with social care
  colleagues
• Benchmark all health commissioned providers
  against the NICE Quality Standards for End of
  Life Care for Adults - 2011
• Respond to the scrutiny recommendations

Email - gordon.pownall_at_hertfordshire.nhs.uk Tel
- 01707 369777